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Health Care, Insurance, and Other Costs. Traveler understands that UA does not accept
responsibility or liability for providing health care services or health care insurance for Traveler in
regard to the Travel or otherwise.
Personal Automobiles. UA does not accept responsibility or liability for providing automobile or
travelers insurance for Traveler, or for any other costs incurred in connection with the Travel, such
as gas, wear or damage to an automobile, towing, etc. UA does not assume any Liabilities, and
Traveler specifically releases UA, holds UA harmless from, and indemnifies UA for any Liabilities
related to personal travel or automobiles.
Indemnification. Traveler agrees to release, hold harmless, and indemnify UA from and against
any and Liabilities related to the Travel, including any and all damages which may be charged by
third parties as a result of property damage or other damage caused by Traveler.
General Terms and Conditions. . Traveler agrees to the General Terms and Conditions: Travel
Funding Requests, which are incorporated herein by reference. In further clarification, but not
limitation of the same, the Traveler understands that his/her student account may be charged in the
event of property or other damage, and that such unpaid charges may prevent subsequent
registration, graduation, and transcript issuance. Failure to meet financial obligations of any kind to
the University could also subject the student to eviction from University housing; suspension of
future services; referral of the students delinquent account to a collection agency; and the
assessment of additional late payment charges, transcript hold fees, attorneys fees, and other costs
and charges necessary for the collection of any amount not paid when due. Traveler further
understands that he/she is bound by the Student Code of Conduct, whether on campus or not.
Acknowledgement. Traveler has read and voluntarily enters into this document, based on his/her
own knowledge. If Traveler is under the age of 19, this document is entered into by Travelers
Parent/Guardian who warrants his/her legal responsibility, custody, and authority to speak for the
Traveler and binds him/herself, Traveler, and their heirs, assigns, and next of kin hereto.
Students name (print): ____________________________________________________
Students Phone: _________________ Students Email: _________________________
Signature of Traveler: ______________________________________________________
Parent/Guardians name (print): _____________________________________________
Signature of Parent/Guardian (if student is under the age of 19):
________________________________________________________________________
Date: ___________________________________________________________________